Clinical Laboratory Testing in the Rheumatic Diseases

The diagnosis of rheumatologic diseases is based on clinical information, blood and imaging tests, and in some cases on histology. Blood tests are useful in confirming clinically suspected diagnosis and monitoring the disease activity. The tests should be used as adjuncts to a comprehensive history and physical examination.

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The 2010 American College of Rheumatology/European League Against Rheumatism classification Criteria for Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint swelling, joint tenderness, and destruction of synovial joints, leading to severe disability and premature mortality. Given the presence of autoantibodies, such as rheumatoid factor (RF) and anti–citrullinated protein antibody (ACPA) (tested as anti–cyclic citrullinated peptide [anti-CCP]), which can precede the clinical manifestation of RA by many years, RA is considered an autoimmune disease.
A joint working group of the ACR and the European League Against Rheumatism (EULAR) was therefore formed to develop a new approach for classification of RA.

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Criterios de Clasificación de Dermatomiositis y Polimiositis 

La dermatomiositis es una enfermedad idiopática, que incluye miopatía inflamatoria y manifestaciones cutáneas características; la polimiositis incluye la miopatía inflamatoria sin signos cutáneos.

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The 2008 ACR Recommendations for Rheumatoid Arthritis Treatments

  • Initiating treatment with methotrexate or Arava (leflunomide) was recommended for most rheumatoid arthritis patients.
  • Methotrexate plus Plaquenil (hydroxychloroquine) was recommended for rheumatoid arthritis patients with moderate to high disease activity.

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Criteria for the Classification of Wegener’s Granulomatosis (WG)

Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a rare form of vasculitis. In this disorder, small-sized blood vessels in the nose, sinuses, ears, lungs and kidneys become inflamed and damaged.

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Diagnostic Criteria for Thromboangiitis Obliterans (Buerger’s Disease)

Since specificity of Buerger’s disease is characterized by peripheral ischemia of an inflammatory nature and with a self-limiting course, diagnostic criteria should be discussed from clinical of view.

Several different criteria have been proposed for the diagnosis of thromboangiitis obliterans:

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Criteria for the Classification of Takayasu Arteritis

Takayasu arteritis (TA) is a chronic large vessel vasculitis that affects aorta, its main branches and pulmonary arteries. The inflammatory process results in stenosis, occlusion, dilation or aneurysm formation in the arterial wall.

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Criteria for Diagnosis of Still’s Disease

Yamaguchi criteria for classification of adult Still’s disease

Presence of 5 or more criteria, of which at least 2 are Major (96% sensitivity; 92% specificity)

Yamaguchi criteria for classification of adult Still’s disease
Presence of 5 or more criteria, of which at least 2 are Major (96% sensitivity; 92% specificity)

Major Criteria

  • Temperature of >39°C for >1 wk
  • Leukocytosis >10,000/mm3 with >80% PMNs
  • Typical rash
  • Arthralgias >2 wk

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